Individual
MARY RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
497 WEST 4TH STREET, DOVE CREEK, CO 81324-0368
(970) 677-2387
(970) 677-2948
Mailing address
PO BOX 368, DOVE CREEK, CO 81324-0368
(970) 677-2387
(970) 677-2948
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
115016
CO
Other
Enumeration date
05/23/2012
Last updated
05/23/2012
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